Suboxone?

i have been on suboxone about 3 months. my dose is 16mg daily. i stopped taking it 4 days ago as i will be having dental surgery today. will the pain meds work? and i am a little confused will taking the lortab cause withdrawl? or is that only if i start my suboxone too soon after taking the lortab?

Responses (2)

First of all 16mg is way too high a dose. The lortabs won't work very well taking a normal dose. I'm available to help you get off the subs if that is what you want to do. Let me know if you want my help. I'm on the drugs.com forum every day. God bless.

Hey Robert... my name is christopher and i'm currently trying to get off of suboxone... Starting in 2004 i did a 4 day suboxone detox on about 3 or 4 seperate occasions. Due to my inability to admit my powerlessness over my addiction, it never took long til i screwed up. Long story short, i've been on Suboxone maintenance for about 5 years now. I was up to 32mg/day, and have now been on 16mg/day for the last 2.5 years. I've been a drug addict for the past 15 years, and have recently recommitted myself to the narcotics anonymous program. It is the only thing that has ever worked for me for any lenght of time. So now that i have the resources and support network in my life, i want off of this stuff. My doctor of course suggests coming down by 2mg at a time, and doing this over the coars of a number of months, possibly a year. My thing is that i don't feel like i am truly "clean" going to meetings if i am taking suboxone.

I asked my doctor today about a rapid detox, but of course he doesn't suggest it. I don't have the funds to do an RDD (which is some sort of rapid detox in which you are put under anestesia and stuff. Anyway, i am really scared of the withdrawals, and of the mental part of stopping. For me, it is a very mental thing to take my two pills everyday. I've convinced myself that i don't feel good w/o it. I did it cold turkey once and was horribly sick. This was before i knew of the terrible side effects. anyway, i am open to any suggestions... my main goal is to not want to go back to shooting heroin again... i am very apprehensive and stuggling with this. i don't tell a lot of people in meetings b/c they would frown upon this, and the few close people i do tell, suggest that i simply stop... but they don't know much about the drug... anyway, let me know if you have any suggestions, ideas, links to sites, anything at all... thank you... god bless

I have been on 8 mg. of Suboxone for 3 months and I am having hand surgery so I was looking for answers about taking my medication or discontinuing it temporarily. My prescribing doctor told me it is also used for pain relief and to just continue taking it, but I did not feel that his answer was detailed or informative so I researched it. This is what I found in the latest research on www.naabt.org:

Clinical experience treating acute pain in patients receiving maintenance therapy with buprenorphine is limited. Pain treatment with opioids is complicated by the high affinity of buprenorphine for the receptor. Thishigh affinity risks displacement of, or competition with full opioid agonist analgesics when buprenorphine is administered concurrently or sequentially. There are several possible approaches for treating acute pain that requires opioid analgesia in the patient receiving buprenorphinetherapy (Table 2). With such limited clinical experience, the following treatment approaches are based on available literature, pharmacologic principles, and published recommendations. The most effective approach will be elucidated with increased clinical experience. In all cases, because of highly variable rates of buprenorphine dissociationfrom the receptor, naloxone should be available and level of consciousness and respiration should be frequently monitored.

Treatment options are as follows.1. Continue buprenorphine maintenance therapy and titrate a short-acting opioid analgesic to effect (90, 98). Because higher doses of full opioid agonist analgesics may be required to compete with buprenorphine at the receptor, caution should be taken if the patient’s buprenorphinetherapy is abruptly discontinued. Increased sensitivity to the full agonist with respect to sedation and respiratory depression could occur.2. Divide the daily dose of buprenorphine and administer it every 6 to 8 hours to take advantage of its analgesic properties. For example, for buprenorphine at 32 mg daily, the split dose would be 8 mg every 6 hours. The available literature suggests that acute pain can be effectively managed with as little as 0.4 mg of buprenorphine given sublinguallyevery 8 hours in patients who are opioid naive (47, 99, 100). However, these low doses may not provide effective analgesia in patients with opioid tolerance who are receiving OAT. Therefore, in addition to divided dosing of buprenorphine, effective analgesia may require the use ofadditional opioid agonist analgesics (for example, morphine). 3. Discontinue buprenorphine therapy and treat the patient with full scheduled opioid agonist analgesics by titrating to effect to avoid withdrawal and then to achieve analgesia (for example, sustained-release and immediaterelease morphine) (90, 98, 101). With resolution of theacute pain, discontinue the full opioid agonist analgesic and resume maintenance therapy with buprenorphine, using an induction protocol (98, 102).4. If the patient is hospitalized with acute pain, his or her baseline opioid requirement can be managed and opioid withdrawal can be prevented by converting buprenorphine to methadone at 30 to 40 mg/d. At this dose, methadone will prevent acute withdrawal in most patients (97) and, unlike buprenorphine, binds less tightly to the receptor. Thus, responses to additional opioid agonist analgesics will be as expected (that is, increasing dose will provide increasing analgesia). If opioid withdrawal persists, subsequent daily methadone doses can be increased in 5- to10-mg increments (103). This method allows titration of the opioid analgesic for pain control in the absence of opioid withdrawal. When the acute pain resolves, discontinue the therapy with the full opioid agonist analgesic and methadone and resume maintenance therapy with buprenorphine, using an induction protocol (98, 102). If the patient is discharged while full opioid agonist analgesics are still required, then discontinue methadone therapy and treat the patient as stated in the third buprenorphine approach. If buprenorphine therapy needs to be restarted (buprenorphine induction) after acute pain management (that is, the third and fourth approaches), it is important to keep in mind that buprenorphine can precipitate opioid with-drawal. Thus, a patient receiving a full opioid agonist regularly should be in mild opioid withdrawal before restartingbuprenorphine therapy (98, 102).Acute PainManagement for Patients Receiving OAT Perspective www.annals.org 17 January 2006 Annals of Internal Medicine Volume 144 • Number 2 131